Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, United Kingdom.
Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom.
PLoS One. 2021 Jun 25;16(6):e0253667. doi: 10.1371/journal.pone.0253667. eCollection 2021.
A living-donor kidney transplant (LDKT) is one of the best treatments for kidney failure. The UK's LDKT activity falls behind that of many other countries, and there is evidence of socioeconomic inequity in access. We aimed to develop a UK-specific multicomponent intervention to support eligible individuals to access a LDKT. The intervention was designed to support those who are socioeconomically-deprived and currently disadvantaged, by targeting mediators of inequity identified in earlier work. We identified three existing interventions in the literature which target these mediators: a) the Norway model (healthcare practitioners contact patients' family with information about kidney donation), b) a home education model, and c) a Transplant candidate advocate model. We undertook intervention development using the Person-Based Approach (PBA). We performed in-depth qualitative interviews with people with advanced kidney disease (n = 13), their family members (n = 4), and renal and transplant healthcare practitioners (n = 15), analysed using thematic analysis. We investigated participant views on each proposed intervention component. We drafted intervention resources and revised these in light of comments from qualitative 'think-aloud' interviews. Four general themes were identified: i) Perceived cultural and societal norms; ii) Influence of family on decision-making; iii) Resource limitation, and iv) Evidence of effectiveness. For each intervention discussed, we identified three themes: for the Norway model: i) Overcoming communication barriers and assumptions; ii) Request from an official third party, and iii) Risk of coercion; for the home education model: i) Intragroup dynamics; ii) Avoidance of hospital, and iii) Burdens on participants; and for the transplant candidate advocates model: i) Vested interest of advocates; ii) Time commitment, and iii) Risk of misinformation. We used these results to develop a multicomponent intervention which comprises components from existing interventions that have been adapted to increase acceptability and engagement in a UK population. This will be evaluated in a future randomised controlled trial.
活体供肾移植（LDKT）是治疗肾衰竭的最佳方法之一。英国的 LDKT 活动落后于许多其他国家，并且在获得途径方面存在社会经济不平等的证据。我们旨在开发一种英国特有的多组分干预措施，以支持符合条件的个人接受 LDKT。该干预措施旨在通过针对早期工作中确定的不平等中介因素，为那些社会经济贫困和目前处于不利地位的人提供支持。我们在文献中确定了三种针对这些中介因素的现有干预措施：a）挪威模式（医疗保健从业者与患者的家属联系，提供有关肾脏捐赠的信息），b）家庭教育模式，和 c）移植候选人倡导者模式。我们使用基于人的方法（PBA）进行干预措施的开发。我们对 13 名晚期肾病患者、他们的家属（n=4）和肾脏和移植医疗保健从业者（n=15）进行了深入的定性访谈，使用主题分析进行分析。我们调查了参与者对每个拟议干预措施的看法。我们起草了干预措施资源，并根据定性“思考 aloud”访谈的意见进行了修订。确定了四个一般主题：i）感知的文化和社会规范；ii）家庭对决策的影响；iii）资源限制，和 iv）有效性证据。对于讨论的每种干预措施，我们确定了三个主题：对于挪威模式：i）克服沟通障碍和假设；ii）来自官方第三方的请求，和 iii）胁迫的风险；对于家庭教育模式：i）群体内部动态；ii）避免医院，和 iii）参与者的负担；对于移植候选人倡导者模式：i）倡导者的既得利益；ii）时间承诺，和 iii）错误信息的风险。我们使用这些结果开发了一种多组分干预措施，该措施由现有干预措施的组成部分组成，这些组成部分经过调整以提高在英国人群中的可接受性和参与度。这将在未来的随机对照试验中进行评估。
